Overview of Healthcare in The UK

Received 2010 Sep 1; Accepted 2010 Sep 27; Issue date 2010 Dec.

. The National Health System in the UK has actually evolved to become one of the biggest healthcare systems in the world. At the time of writing of this evaluation (August 2010) the UK federal government in its 2010 White Paper "Equity and excellence: Liberating the NHS" has actually announced a method on how it will "create a more responsive, patient-centred NHS which accomplishes outcomes that are among the very best in the world". This evaluation article provides an overview of the UK healthcare system as it presently stands, with focus on Predictive, Preventive and Personalised Medicine elements. It aims to serve as the basis for future EPMA short articles to broaden on and present the changes that will be executed within the NHS in the upcoming months.

Keywords: UK, Healthcare system, National health system, NHS

Introduction

The UK healthcare system, National Health Service (NHS), came into existence in the aftermath of the Second World War and ended up being functional on the 5th July 1948. It was first proposed to the Parliament in the 1942 Beveridge Report on Social Insurance and Allied Services and it is the tradition of Aneurin Bevan, a former miner who became a political leader and the then Minister of Health. He founded the NHS under the principles of universality, totally free at the point of shipment, equity, and paid for by central funding [1] Despite many political and organisational changes the NHS remains to date a service readily available widely that takes care of people on the basis of requirement and not ability to pay, and which is moneyed by taxes and nationwide insurance contributions.

Health care and health policy for England is the obligation of the central federal government, whereas in Scotland, Wales and Northern Ireland it is the obligation of the respective devolved governments. In each of the UK nations the NHS has its own distinct structure and organisation, however overall, and not dissimilarly to other health systems, health care consists of two broad sections; one handling method, policy and management, and the other with actual medical/clinical care which remains in turn divided into primary (community care, GPs, Dentists, Pharmacists etc), secondary (hospital-based care accessed through GP recommendation) and tertiary care (professional healthcare facilities). Increasingly differences between the 2 broad sections are ending up being less clear. Particularly over the last years and guided by the "Shifting the Balance of Power: The Next Steps" (2002) and "Wanless" (2004) reports, steady modifications in the NHS have actually resulted in a greater shift towards local instead of main choice making, elimination of barriers in between main and secondary care and more powerful emphasis on client option [2, 3] In 2008 the previous federal government strengthened this instructions in its health method "NHS Next Stage Review: High Quality Take Care Of All" (the Darzi Review), and in 2010 the present government's health technique, "Equity and quality: Liberating the NHS", remains helpful of the same concepts, albeit through potentially various systems [4, 5]

The UK government has actually simply revealed plans that according to some will produce the most transformation in the NHS considering that its creation. In the 12th July 2010 White Paper "Equity and quality: Liberating the NHS", the current Conservative-Liberal Democrat coalition federal government outlined a strategy on how it will "develop a more responsive, patient-centred NHS which achieves results that are among the finest on the planet" [5]

This evaluation article will for that reason provide an overview of the UK healthcare system as it presently stands with the goal to function as the basis for future EPMA posts to expand and present the modifications that will be executed within the NHS in the forthcoming months.

The NHS in 2010

The Health Act 2009 established the "NHS Constitution" which officially unites the purpose and principles of the NHS in England, its values, as they have been established by patients, public and personnel and the rights, promises and obligations of clients, public and staff [6] Scotland, Northern Ireland and Wales have likewise consented to a high level declaration declaring the principles of the NHS throughout the UK, even though services may be supplied differently in the four countries, reflecting their various health needs and situations.

The NHS is the largest company in the UK with over 1.3 million staff and a budget of over ₤ 90 billion [7, 8] In 2008 the NHS in England alone utilized 132,662 physicians, a 4% increase on the previous year, and 408,160 nursing staff (Table 1). Interestingly the Kings Fund approximates that, while the overall variety of NHS staff increased by around 35% in between 1999 and 2009, over the same duration the number of supervisors increased by 82%. As a proportion of NHS staff, the number of managers rose from 2.7 per cent in 1999 to 3.6 percent in 2009 (www.kingsfund.org.uk). In 2007/8, the UK health spending was 8.5% of Gdp (GDP)-with 7.3% accounting for public and 1.2% for personal costs. The net NHS expense per head across the UK was most affordable in England (₤ 1,676) and greatest in Scotland (₤ 1,919) with Wales and Northern Ireland at around the same level (₤ 1,758 and ₤ 1,770, respectively) [8]

Table 1.

The circulation of NHS labor force according to primary personnel groups in the UK in 2008 (NHS Information Centre: www.ic.nhs.uk)

The general organisational structure of the NHS in England, Scotland, Wales and Northern Ireland in 2010 is shown in Fig. 1. In England the Department of Health is accountable for the instructions of the NHS, social care and public health and shipment of healthcare by establishing policies and strategies, protecting resources, keeping track of efficiency and setting national standards [9] Currently, 10 Strategic Health Authorities manage the NHS at a regional level, and Primary Care Trusts (PCTs), which currently manage 80% of the NHS' budget, offer governance and commission services, in addition to ensure the availability of services for public heath care, and arrangement of neighborhood services. Both, SHAs and PCTs will disappear once the plans outlined in the 2010 White Paper become carried out (see area listed below). NHS Trusts run on a "payment by results" basis and acquire most of their income by supplying healthcare that has been commissioned by the practice-based commissioners (GPs, etc) and PCTs. The primary types of Trusts consist of Acute, Care, Mental Health, Ambulance, Children's and Foundation Trusts. The latter were produced as non-profit making entities, without government control however likewise increased monetary obligations and are controlled by an independent Monitor. The Care Quality Commission regulates independently health and adult social care in England overall. Other professional bodies offer financial (e.g. Audit Commission, National Audit Office), treatment/services (e.g. National Patient Safety Agency, Medicines and Healthcare Products Regulatory Agency) and professional (e.g. British Medical Association) policy. The National Institute for Health and Clinical Excellence (NICE) was established in 1999 as the body responsible for establishing nationwide guidelines and standards associated with, health promo and prevention, assessment of new and existing innovation (including medications and treatments) and treatment and care clinical guidance, available throughout the NHS. The health research strategy of the NHS is being executed through National Institute of Health Research (NIHR), the total budget for which was in 2009/10 close to ₤ 1 billion (www.nihr.ac.uk) [10]

Fig. 1.

Organisation of the NHS in England, Scotland, Wales and Northern Ireland, in 2010

Section 242 of the NHS Act states that Trusts have a legal task to engage and involve patients and the general public. Patient experience information/feedback is formally gathered nationally by yearly study (by the Picker Institute) and belongs to the NHS Acute Trust efficiency framework. The Patient Advice Liaison Service (PALS) and Local Involvement Networks (LINks) support client feedback and participation. Overall, inpatients and outpatients studies have revealed that patients rate the care they receive in the NHS high and around three-quarters indicate that care has actually been great or exceptional [11]

In Scotland, NHS Boards have actually replaced Trusts and provide an integrated system for tactical instructions, performance management and scientific governance, whereas in Wales, the National Delivery Group, with suggestions from the National Board Of Advisers, is the body performing these functions (www.show.scot.nhs.uk; www.wales.nhs.uk). Scottish NHS and Special Boards provide services, with care for specific conditions delivered through Managed Clinical Networks. Clinical guidelines are published by the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium (SMC) recommendations on making use of new drugs in the Scottish NHS. In Wales, Local Heath Boards (LHBs) strategy, protected and deliver healthcare services in their areas and there are 3 NHS Trusts supplying emergency situation, cancer care and public health services nationally. In Northern Ireland, a single body, the Health and Care Board is supervising commissioning, performance and resource management and enhancement of healthcare in the nation and 6 Health and Social Care Trusts deliver these services (www.hscni.net). A variety of health firms support secondary services and deal with a large variety of health and care issues consisting of cancer screening, blood transfusion, public health etc. In Wales Community Health Councils are statutory lay bodies advocating the interests of the general public in the health service in their district and in Northern Ireland the Patient and Client Council represent patients, clients and carers.

Predictive, Preventive and Personalised Medicine (PPPM) in the NHS

Like other national healthcare systems, predictive, preventive and/or customised medication services within the NHS have typically been offered and are part of disease diagnosis and treatment. Preventive medication, unlike predictive or personalised medication, is its own established entity and relevant services are directed by Public Health and provided either through GP, social work or hospitals. Patient-tailored treatment has constantly prevailed practice for good clinicians in the UK and any other healthcare system. The terms predictive and personalised medication though are evolving to describe a far more highly sophisticated method of identifying disease and predicting response to the requirement of care, in order to increase the advantage for the client, the general public and the health system.

References to predictive and customised medication are progressively being presented in NHS associated details. The NHS Choices website explains how clients can get customised suggestions in relation to their condition, and uses information on predictive blood test for disease such as TB or diabetes. The NIHR through NHS-supported research study and together with academic and business working together networks is investing a substantial proportion of its budget in confirming predictive and preventive healing interventions [10] The previous government considered the development of preventive, people-centred and more efficient healthcare services as the means for the NHS to react to the difficulties that all contemporary health care systems are facing in the 21st century, namely, high client expectation, aging populations, harnessing of details and technological development, changing labor force and evolving nature of disease [12] Increased focus on quality (patient safety, client experience and clinical efficiency) has likewise supported innovation in early diagnosis and PPPM-enabling technologies such as telemedicine.

A number of preventive services are provided through the NHS either by means of GP surgical treatments, social work or hospitals depending upon their nature and include:

The Cancer Screening programmes in England are nationally coordinated and include Breast, Cervical and Bowel Cancer Screening. There is also a notified option Prostate Cancer Risk Management program (www.cancerscreening.nhs.uk).

The Child Health Promotion Programme is handling issues from pregnancy and the very first 5 years of life and is delivered by neighborhood midwifery and health visiting teams [13]

Various immunisation programs from infancy to adulthood, used to anybody in the UK for totally free and typically provided in GP surgeries.